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Application of Electrophysiologic Techniques in Poor Outcome Prediction Among Patients With Severe Focal and Diffuse Ischemic Brain Injury

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机构： [1]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China [2]Department of Neurology, University of Cologne, Cologne, Germany

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关键词： EEG evoked potentials coma anoxic-ischemic encephalopathy stroke outcome prediction

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Objective: To explore various electrophysiologic examinations as predictors for poor outcome in patients with severe ischemic brain injury, by comparing the prognostic ability of EEG, short-latency somatosensory evoked potentials (SLSEP), and brain stem auditory evoked potentials (BAEP). Methods: EEG, SLSEP, and BAEP were recorded in 161 patients with severe ischemic brain injuries (Glasgow Coma Scale <= 8), 77 with anoxic-ischemic encephalopathy after cardiopulmonary resuscitation, while 84 experienced massive hemispheric infarction at between 1 and 7 days after the onset. Outcomes were reviewed after 6 months using the Glasgow Outcome Scale. Results: Six months after the onset, poor outcomes (Glasgow Outcome Scale, 1-2) were identified in 66 and 54 patients among the anoxic-ischemic encephalopathy and the massive hemispheric infarction group, respectively. By using the prognostic authenticity analysis of predictors, unfavorable EEG patterns, lack of EEG reactivity, pathologic N20 of SLSEP, and pathologic wave V of BAEP showed the high sensitivity (92.4%-97.0%, 95% confidence interval [CI]: 82.5%-99.5%), while bilateral absence of SLSEP N20 showed the highest specificity (100%, 95% CI: 67.9%-100%) and positive predictive value (100%, 95% CI: 90.4%-100%) in the anoxic-ischemic encephalopathy group. In the massive hemispheric infarction group, unfavorable EEG patterns showed the highest sensitivity (96.3%, 95% CI: 86.2%-99.4%) while bilateral absence of SLSEP N20 and BAEP wave V showed the highest specificity (100%, 95% CI: 85.9%-100%) and positive predictive value (100%, 95% CI: 80.8%-100%). Conclusions: The predictive power of electrophysiologic examinations is different according to the etiology of ischemic brain injury. Short-latency somatosensory evoked potentials (N20) can be considered the most powerful method to predict poor outcome in anoxic-ischemic encephalopathy. Combination of EEG (unfavorable EEG patterns) and SLSEP (N20)/BAEP (wave V) is best suited in massive hemispheric infarction to predict poor outcome.

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出版当年[2010]版：

大类 | 4 区医学

小类 | 4 区临床神经病学 4 区神经科学

最新[2023]版：

大类 | 4 区医学

小类 | 4 区临床神经病学 4 区神经科学

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出版当年[2009]版：

Q3 CLINICAL NEUROLOGY Q4 NEUROSCIENCES

最新[2023]版：

Q3 CLINICAL NEUROLOGY Q3 NEUROSCIENCES

影响因子： 2.3 最新[2023版] 2.1 最新五年平均 1.472 出版当年[2009版] 2.43 出版当年五年平均 1.74 出版前一年[2008版] 1.154 出版后一年[2010版]

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第一作者机构： [1]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China

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